Doctors are the primary medical professionals who determine when a patient needs placement alternatives to home discharge. However, doctors call on the expertise of the other medical professionals involved in the patient's care. Occupational therapists, physical therapists, speech therapists and social workers contribute to the decision-making process by educating the doctor about the level of independence of the patient and the limiting factors.
Definition of Assisted Living
Assisted living facilities, or ALFs, are for residents who are still physically independent but require assistance for high-level activities. ALFs are geared toward residents who are too independent for a skilled nursing facility but are not able to return home safely.
Level of Care
Although each ALF provides different amenities and services, there are basic guidelines for the level of care that assisted living facilities offer. ALFs must have certified nursing assistants available to assist residents with activities like laundry, meal preparation and emergency service notification in the event of a fall or other medical change. Nurses are available an average of once a week, so residents must be able to administer their own daily medication. Some facilities have doctors who visit the facility, but most residents need to travel to their doctor's office for exams. Because of the low staff-to-resident ratio, residents need to be able to complete their own bathing, dressing and basic room cleaning independently.
Medical Factors
Physicians sometimes place a patient in assisted living because of the patient's fluctuating medical status. Those patients who can maintain physical independence but might change in their medical health would be appropriate for ALF placement. The assisted living facility can provide the support to determine if a resident needs examination at the doctor's office or hospital. This can alleviate the concerns of family members about patients with fluctuating health.
Involvement from other Medical Professionals
In most cases, physicians determine when to send a patient to an assisted living facility based upon the patient's functional independence. But since doctors might only see a patient for a few minutes during a typical exam in the office, hospital or rehabilitation facility, they rely on other medical professionals for advice and guidance. Occupational therapists provide input regarding the patient's safety and independence with bathing, dressing, cooking and cleaning. Physical therapists help determine the patient's needs during ambulation and navigating stairs. Speech therapists address confusion and poor problem-solving skills and limited safety awareness, and educate the physician on the patient's cognitive status. Social workers provide information about the patient's home environment and support system, or lack thereof.
Alternatives
When a patient requires more assistance than an ALF can provide, physicians might recommend personal care home or nursing home placement. The most disabled and confused patients require nursing home placement. If the patient is resistant to any placement other than return to home, the doctor may recommend home health services including therapy, nursing and home health aides.
